研究者詳細 - 杉生　憲志

論文 - 杉生　憲志

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Direct surgery for paraclinoid aneurysm arising from the anterolateral wall of the internal carotid artery 査読

K Onoda, K Tokunaga, K Sugiu, S Ono, Date, I

NEUROLOGICAL SURGERY 34 ( 3 ) 267 - 272 2006年3月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：IGAKU-SHOIN LTD

The internal carotid aneurysm (ICA) arising from the paraclinoid region is associated with the origins of the superior hypophyseal artery and the ophthalmic artery. Recently, other aneurysms which can arise in this region without imvolvement of the arterial branches has been reported. Among those aneurysms, there are very rare type of aneurysms located on the anterolateral aspect of the internal carotid artery.
In this report, we described our experience with direct surgery for five cases of the unruptuted paraclinoid aneurysm arising from the anterolateral aspect of the ICA.
Firstly, the conmon carotid artery was exposed to carry out proximal flow control. We used the pterional approach. The anterior clinoid process was deleted after having confirmed aneurysm and the dural ring was incised. Extreme care had to be taken during this step. All patients underwent Successful neck clipping.
In recent two cases we employed the neuroendoscope (EndoArmTM) to observe the unrecognized area of surgical microscope and untrasonic bone curette (SONOPETTM) to perform the safe removal of the anterior clinoid process. This procedure is very useful for carring out the neck clipping for aneurysms which are located oil the anterolateral aspect of the internal carotid artery.

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経皮的椎体形成術による多発性骨髄腫腰椎病変の1治験例

大西学, 徳永浩司, 杉生憲志, 小野田惠介, 三好康之, 生口俊浩, 金澤右, 増成太郎, 谷本光音, 伊達勲

岡山医学会雑誌 117 ( 3 ) 256 - 256 2006年1月

[Percutaneous vertebroplasty combined with radiofrequency ablation for a patient with a spinal metastatic tumor: case report].

Koji Tokunaga, Kenji Sugiu, Yasuyuki Miyoshi, Hidefumi Mimura, Susumu Kanazawa, Isao Date

No shinkei geka. Neurological surgery 33 ( 8 ) 811 - 5 2005年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Recent technological development has allowed expanding applications of radiofrequency ablation (RFA) for malignant tumor therapy. We report a case with a spinal metastatic tumor treated with combination of percutaneous vertebroplasty (PVP) that provides pain relief and spinal stabilization and RFA. A 68-year-old male who had undergone resection of left ureteric carcinoma was referred to our hospital with lower back pain due to the fifth lumbar (L5) vertebral metastatic tumor. Conventional radiation therapy was discontinued because of pneumonia. One year later, the patient was admitted again with weakness of the right knee and foot and severe pain of the back and the right lower extremity. Radiographs demonstrated a compressive fracture of the L5 vertebra predominantly on the right side. CT and MRI showed a tumor of the L5 body invading the right pedicle, the intervertebral foramen, and the retroperitoneal space. RFA was performed in the ventral part of the L5 body, and then around the right L5/the first sacral intervertebral foramen. Temperature and time for ablation ranged from 74 degrees C to 95 degrees C and from 11 min. to 30 min., respectively. Next, PVP was performed by the right transpedicular approach. Bone cement was injected into the L5 body and the pedicle by an amount of 3.0 ml in total without technical complications. Postoperatively, visual analogue scale demonstrated decreased pain degree from 10 cm to 5.4 cm. Combined treatment with RFA and PVP is a feasible and promising procedure for spinal metastatic tumors. Further evaluation is necessary to confirm its long-term efficacy.

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[Assessment of the perianeurysmal environment of unruptured internal carotid-posterior communicating artery aneurysms with fusion imaging of three-dimensional magnetic resonance cisternography and angiography]. 査読

Satoh T, Omi M, Ohsako C, Katsumata A, Yoshimoto Y, Tsuchimoto S, Onoda K, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 33 ( 6 ) 569 - 577 2005年6月

Local intraarterial fibrinolysis in central retinal artery occlusion: Case report 査読

M Tagawa, K Sugiu, K Tokunaga, W Sasahara, K Watanabe, N Tamesa, S Ono, K Onoda, Date, I

NEUROLOGICAL SURGERY 33 ( 6 ) 619 - 623 2005年6月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：IGAKU-SHOIN LTD

The authors report a case of local intraarterial fibrinolysis (LIF) in central retinal artery occlusion (CRAO). A 79-year-old man with stenosis of the left internal carotid artery (ICA) suffered sudden loss of vision in his left eye. LIF was carried out using a microcatheter in the origin of the ophthalmic artery on the side of the CRAO. Treatment was performed with 120,000 IU of urokinase. After LIF, marked improvement of vision was established. No complication occurred during LIF One month later, carotid artery stenting was performed for the left ICA stenosis. We consider LIF in CRAO is effective treatment.

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[Assessment of the signal intensity distribution pattern within the unruptured cerebral aneurysms using color-coded 3D MR angiography]. 査読

Satoh T, Omi M, Ohsako C, Katsumata A, Yoshimoto Y, Tsuchimoto S, Kunishio K, Onoda K, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 33 ( 5 ) 445 - 454 2005年5月

Combination therapy for cerebral vasospasm after SAH: Importance of spinal drainage and Intraarterial injection of fasudil hydrochloride 査読

S Ono, K Onoda, K Tokunaga, K Sugiu, Date, I

Proceedings of the 13th World Congress of Neurological Surgery, Vols 1 and 2 379 - 385 2005年

記述言語：英語掲載種別：研究論文（国際会議プロシーディングス）出版者・発行元：MEDIMOND S R L

Introduction: We hypothesize that the combination therapy of lumbar drainage (LD) with intraarterial injection of Fasudil hydrochloride for cerebral vasospasm (VS) can improve the prognosis of the patients of SAH compared with the therapy of cisternal drainage (CD) with the arterial injection of Fasudil hydrochloride (FH). Materials and Methods: Forty-four patients with aneurysmal SAH who were admitted to our University between January 2003 and April 2005. The treatment group consisted of 30 patients in whom a LD had been placed with intraarterial FH, if necessary, whereas the control group was composed of 14 patients who received the CD with same interventional treatment, if necessary. Age, gender, Hunt and Kosnik grade (H & K), Fisher group, a VS rate, and a rate of normal pressure hydrocephalus (NPH) were compared between these two groups. Primary endpoint was set using Glasgow outcome scale (GOS) after 3 months from onset. Results: There was no difference of age, gender, H & K, and Fisher group between these two groups. Intraarterial FH injection was performed in 20% and 50% of the LD and CD groups, respectively. The rate of angiographic VS in the CD group was significantly higher than that in the LD group (36.7% and 85.7% respectively). Symptomatic VS occurred frequently in the CD group compared with that in the LD group. There was statistically significance between these groups (64.3% vs 23.3%). NPH was noted in 13.3% of the LD group and 42.9% of the CD group. However, regarding GOS there was no statistical difference between these two groups. Conclusions: Although outcome of these groups have no statistical difference, these results indicate that LD was more effective for preventing VS after SAH compared with CD. The combination therapies for VS using LD and intraarterial FH injection can improve the prognosis of VS after SAH, and it should be considered as a new multimodality therapy for the treatment of the patients with SAH.

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Endovascular treatment for ruptured vertebral artery dissecting aneurysms 査読

K Sugiu

NEUROLOGICAL SURGERY 32 ( 12 ) 1229 - 1238 2004年12月

Complications of embolization for cerebral arteriovenous malformations 査読

K Sugiu, K Tokunaga, W Sasahara, K Watanabe, A Nishida, S Ono, S Nishio, Date, I, DA Rufenacht

INTERVENTIONAL NEURORADIOLOGY 10 59 - 61 2004年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：EDIZIONI CENTAURO

Embolization is recognized as an important adjunct in the treatment of cerebral arteriovenous malformations (AVMs). We reviewed our results of embolizations for AVMs and discussed procedure-related complications. Eleven complications were recorded in 68 consecutive patients (16%). Of these, four were technical problems including a glued catheter, inability to withdraw the catheter, vessel perforation by the microcatheter, and coil migration. Other complications included three cases of ischemic symptoms due to retrograde thrombosis, two cases of asymptomatic cerebral infarction, one case of asymptomatic small haemorrhage due to venous occlusion, and one case of post-embolization haemorrhage of unknown etiology. Our morbidity rate was 7%, mortality rate was 0%, and asymptomatic complication rate was 9%, retorospectively. Further improvements to endovascular techniques and devices are required.

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[A case of convulsion during selective intra-arterial infusion of fasudil hydrochloride for treatment of vasospasm following subarachnoid hemorrhage].

Wataru Sasahara, Shigeki Ono, Koji Tokunaga, Kenji Sugiu, Hiroyuki Nakashimia, Isao Date, Takashi Ohmoto

No shinkei geka. Neurological surgery 32 ( 5 ) 487 - 91 2004年5月

記述言語：日本語掲載種別：研究論文（学術雑誌）

The authors report a case of convulsion during intra-arterial selective infusion of fasudil hydrochloride (FSD) for treatment of vasospasm following subarachnoid hemorrhage (SAH). A 47-year-old man (Hunt and Kosnik grade I) presented with sudden onset of headache and was diagnosed with SAH on CT, and admitted to our hospital. Digital subtraction angiography (DSA) performed on admission revealed an anterior communicating artery aneurysm. Neck clipping of the aneurysm was performed on the same day and no neurological deficits were noted postoperatively. Motor aphasia appeared on day 11 after the operation, and emergency DSA revealed vasospasm of the left middle cerebral artery and its branches. Emergency percutaneous transluminal angioplasty was performed with successful dilation of the left M1 artery, and 25 milligrams of FSD was injected into the left M1 artery selectively. During this injection, right hemifacial convulsion appeared, and three minutes later disappeared. No treatment was needed for the seizure. Additional injection of 30 milligrams of FSD into the left internal carotid artery resulted in vasodilatation of the left M1 artery and its branches, improvement of their blood flow on angiography, and recovery from motor aphasia. The patient was discharged 1 month later with no neurological deficits. Intra-arterial selective infusion of FSD plays an important role in treatment for vasospasm following SAH, however, we must be aware of risks of complications such as convulsion.

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[Evaluation of the contours and perianeurysmal environment of unruptured cerebral aneurysms, using three-dimensional magnetic resonance cisternogram]. 査読

Satoh T, Ekino C, Ohsako C, Katsumata A, Onoda K, Tsuchimoto S, Yunoki M, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 32 ( 3 ) 215 - 221 2004年3月

サル脳動脈瘤モデルへのアデノウイルスによるTGF-b-1遺伝子治療の試み

小野成紀, 菱川朋人, 西口充久, 西尾晋作, 徳永浩司, 杉生憲志, 伊達勲

脳卒中 26 ( 1 ) 208 - 208 2004年3月

TGF-b-1遺伝子導入による血管反応性の変化:脳血管への遺伝子導入を目指して

小野成紀, 菱川朋人, 西口充久, 西尾晋作, 徳永浩司, 杉生憲志, 伊達勲

脳卒中 26 ( 1 ) 209 - 209 2004年3月

[Spontaneous thrombosis of a fusiform aneurysm arising from the distal posterior cerebral artery: case report].

Akihiko Kondo, Takao Yasuhara, Kenji Sugiu, Takashi Ohmoto

No shinkei geka. Neurological surgery 31 ( 2 ) 189 - 93 2003年2月

記述言語：日本語掲載種別：研究論文（学術雑誌）

A 58-year-old woman complaining of a mild headache was admitted to our hospital. MRI 3 months before admission revealed a round lesion at the right quadrigeminal cistern. Cerebral angiograms demonstrated a fusiform aneurysm arising from the parietooccipital artery, which is the distal branch of the right posterior cerebral artery. Repeated MRI and cerebral angiograms performed on admission demonstrated complete thrombosis of an aneurysm and the parent artery without any clinical symptoms. This is the first case of complete spontaneous thrombosis of an aneurysm of the distal posterior cerebral artery. The mechanism of its development and spontaneous thrombosis in a fusiform aneurysm is discussed.

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[Percutaneous vertebroplasty--indications and procedural techniques].

Koji Tokunaga, Kenji Sugiu, Hiroyuki Nakashima, Isao Date, Takashi Ohmoto, Jean-Baptiste Martin, Daniel A Rüfenacht

No shinkei geka. Neurological surgery 31 ( 1 ) 7 - 14 2003年1月

Training in neurovascular intervention 査読

K Sugiu, K Tokunaga, Date, I, T Ohmoto

NEUROLOGICAL SURGERY 30 ( 11 ) 1231 - 1237 2002年11月

[A review of dural arteriovenous fistulas with hemorrhagic onset].

Ayumi Nishida, Kenji Sugiu, Atsushi Katsumata, Noboru Kusaka, Hiroyuki Nakashima, Takashi Ohmoto

No shinkei geka. Neurological surgery 30 ( 10 ) 1059 - 64 2002年10月

記述言語：日本語掲載種別：研究論文（学術雑誌）

The majority of dural arteriovenous fistulas are considered to have a benign clinical course, but some behave more aggressively, causing progressive neurological symptoms and/or intracranial hemorrhage. Several classifications of angiographic findings have been reported to predict what findings might result in catastrophic presentation. Cortical venous drainage has been described as one of the major risk factors of hemorrhage. We reviewed the records of 50 patients with dural arteriovenous fistulas admitted to our institution from 1991 to 2001 and analyzed their venous drainage patterns with reference to Cognard's classification. Six patients had hemorrhagic episodes caused by dural arteriovenous fistula and all of them had retrograde drainage through cerebral veins. The frequency of hemorrhage in Type I and IIa was 0%, in Type IIb it was 33.3%, in Type IIa + b it was 9.1%, in Type III and Type IV it was 50%, and in Type V it was 100%. These results agreed with those of Cognard reported in 1994, and we reconfirmed the usefulness of Cognard's classification. In order to adapt a firm strategy and treat them promptly and aggressively, it is important to be able to recognize what type of dural arteriovenous fistulas are perilous.

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[Ruptured fenestrated aneurysm of vertebral artery union successfully treated by endovascular surgery with GDC].

Mitsuhisa Nishiguchi, Kenji Sugiu, Takashi Ohmoto, Toshikazu Saijyo, Hiroyuki Fujisawa

No shinkei geka. Neurological surgery 30 ( 8 ) 875 - 9 2002年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）

It is difficult to operate on ruptured basilar artery aneurysms in the acute phase because of the anatomical complexity, brain swelling, patients' medical condition, etc., but because there is some risk of rebleeding and/or vasospasm if surgery is delayed, early surgery is recommended. We encountered a rare case of ruptured fenestrated aneurysm of the vertebral artery (VA) union, treated it safely by endovascular surgery with Guglielmi detachable coils (GDCs) in the acute phase, and obtained a good outcome after intensive care. We therefore conclude that endovascular surgery with GDCs is a first-line therapy for fenestrated aneurysms of the VA union in the acute phase after subarachnoid hemorrhage. Fenestrated aneurysms of the VA union are very rare, and long-term follow-up is mandatory.

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Usefulness of dynamic digitized cerebral parenchymography for cerebral vascular disease 査読

K Sugiu, A Nishida, A Katsumata, N Kusaka, H Nakashima, T Ohmoto

NEUROLOGICAL SURGERY 30 ( 4 ) 379 - 388 2002年4月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：IGAKU-SHOIN LTD

Aortic arch injections according to Theron's method have been performed in patients with cerebral ischemia. Digital subtraction angiograms with modified windowing (low and narrow) have been used for better visualization of cerebral parenchymal condition. This "cerebral parenchymography" allows much easier understanding of cerebral parenchymal vascularization on angiographic imaging. Although further study is necessary to estimate accurate cerebral blood flow, this technique can enable an easy and quick understanding of the overall cerebral hemodynamics.

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Successful embolization of a spinal perimedullary arteriovenous fistula with cellulose acetate polymer solution: Technical case report 査読

K Sugiu, T Meguro, H Nakashiama, T Ohmoto

NEUROSURGERY 49 ( 5 ) 1257 - 1260 2001年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

OBJECTIVE AND IMPORTANCE: Spinal perimedullary arteriovenous fistulae are rarely reported in the literature and can be treated via both endovascular and direct surgical approaches. Coils, glues, and balloons have all been used to embolize these fistulae. Cellulose acetate polymer (CAP) solution is a liquid embolic material that was originally developed for thrombosis of cerebral aneurysms. This is the first report of CAP solution being used to treat a spinal perimedullary arteriovenous fistula, with changes in the viscosity of the solution.
CLINICAL PRESENTATION: A 15-year-old boy experienced spinal subarachnoid hemorrhage without any neurological deficits. A radiological examination revealed a spinal perimedullary arteriovenous fistula (Type 2) at the L1 level.
INTERVENTION: Transarterial embolization was performed with local anesthesia. The microcatheter was navigated through the anterior spinal artery to a site just proximal to the fistula. After provocative testing demonstrated negative results, CAP solution was injected and the fistula was completely closed, without complications. The patient experienced an uneventful postoperative course.
CONCLUSION: We describe the usefulness of CAP solution in the treatment of a spinal perimedullary arteriovenous fistula. This procedure must be performed for a larger series of patients for assessment of its long-term results.

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